National Dengue Control Program implementation evaluation in two border municipalities in Mato Grosso do Sul State, Brazil, 2016

Costa, Elisângela Martins da Silva; Cunha, Rivaldo Venâncio da; Costa, Edgar Aparecido da

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 27 (4) • 2018 • https://doi.org/10.5123/S1679-49742018000400007 copy

National Dengue Control Program implementation evaluation in two border municipalities in Mato Grosso do Sul State, Brazil, 2016^* * This article is derived from the Doctoral thesis entitled "Evaluation of the implementation of the Dengue Control Program in border municipalities in Mato Grosso do Sul", defended in 2018 by Elisângela Martins da Silva Costa, at the Postgraduate Program on Public Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to evaluate the degree of implementation of the National Dengue Control Program (PNCD) in two border municipalities in Mato Grosso do Sul State (Corumbá and Ponta Porã), Brazil, 2016.

Methods:

This was a normative evaluation based on indicators of service structure and work process; questionnaires were answered by health professionals involved in dengue prevention and control; the cut-off points used to determine the degree of implementation were 'implemented' (>75% of the activities implemented), 'partially implemented' (50 to 75%), 'low level of implementation' (25 to 49%), and 'not implemented' (<25%).

Results:

383 health professionals participated in this study, 227 of whom were from Corumbá and 156 from Ponta Porã; the degree of PNCD implementation was 63.1% and 66.4% for Corumbá and Ponta Porã, respectively, thus being classified as partially implemented in both municipalities.

Conclusion:

PNCD implementation was partial in both municipalities; problems observed indicate the need for program enhancement.

Keywords:
Dengue; Health Services; Health Program and Project Evaluation; Border Areas; Evaluation Studies

Components and their indicators	ES^a	Degree of implementation
		Corumbá		Ponta Porã
		SA^b	%	SA^b	%
1. Epidemiological Surveillance	49	17.5	35.7	27.2	55.5
1.1 Adequacy of material resources (physical, equipment and supplies)	20	0.0	0.0	0.0	0.0
1.2 Appropriate number of vehicles for implementation of field actions	10	0.0	0.0	10.0	100.0
1.3 Appropriate number of health professionals for the development of practices	10	10.0	100.0	10.0	100.0
1.4 Standards and protocols available to the team	9	7.5	83.3	7.2	80.0
2. Vector combat	59	20.3	34.4	41.0	69.5
2.1 Adequacy of material resources (physical, equipment and supplies)	20	6.0	30.0	11.7	58.5
2.2 Appropriate number of vehicles for implementation of field actions	10	0.0	0.0	10.0	100.0
2.3 Existence of an equipped entomology laboratory	10	5.0	50.0	5.0	50.0
2.4 Appropriate number of health professionals for the development of practices	10	1.5	15.0	7.1	71.0
2.5 Standards and protocols available to the team	9	7.8	86.7	7.2	80.0
3. Assistance to the sick	69	44.2	64.1	47.0	68.1
3.1 Adequacy of material resources (physical, equipment, drugs and supplies)	20	12.3	61.5	13.6	68.0
3.2 Appropriate number of health professionals for the development of practices	10	5.3	53.0	5.0	50.0
3.3 Standards and protocols available to the team	9	5.1	56.7	6.2	68.9
3.4 Adequacy of hospital beds in epidemic period and between epidemic periods	10	1.5	15.0	2.2	22.0
3.5 Existence of municipal and/or reference laboratory to carry out tests	10	10.0	100.0	10.0	100.0
3.6 Existence of contingency plan	10	10.0	100.0	10.0	100.0
4. Integration with Primary Care	10	0.0	0.0	0.0	0.0
4.1 Existence of work flows integrating the activities of community health agents and endemic disease control agents	10	0.0	0.0	0.0	0.0
5. Environmental Sanitation	9	9.0	100.0	9.0	100.0
5.1 Existence of municipal basic sanitation plan	9	9.0	100.0	9.0	100.0
6. Health education, social mobilization and communication	40	37.5	93.7	30.0	75.0
6.1 Existence of Municipal Social Mobilization Committee	10	10.0	100.0	0.0	0.0
6.2 Adequacy of material resources (equipment, folders, posters)	20	17.5	87.5	20.0	100.0
6.3 Existence of health education and social mobilization teams	10	10.0	100.0	10.0	100.0
7. Human resources training	9	0.0	0.0	0.0	0.0
7.1 Existence of municipal training and continuing education plan	9	0.0	0.0	0.0	0.0
8. Legislation	10	10.0	100.0	10.0	100.0
8.1 Existence of municipal legislation that applies penalties to owners of vacant buildings and vacant lots who are negligent with breeding grounds on their property	10	10.0	100.0	10.0	100.0
9. Political-social support	10	10.0	100.0	0.0	0.0
9.1 Existence of intersectoral dengue committee	10	10.0	100.0	0.0	0.0
10. Monitoring and Evaluation	9	9.0	100.0	0.0	0.0
10.1 Existence of Municipal Committee for Monitoring and Evaluating the National Dengue Control Program	9	9.0	100.0	0.0	0.0
Degree of service structure implementation	274	157.5	57.5	164.2	59.9

Components and their indicators	ES^a	Degree of implementation
		Corumbá		Ponta Porã
		SA^b	%	SA^b	%
1. Epidemiological Surveillance	118	90.1	76.3	97.5	82.6
1.1 Appropriate operationalization of the Online Dengue SINAN system	10	10.0	100.0	10.0	100.0
1.2 Notification of all suspected cases of dengue	9	0.0	0.0	0.0	0.0
1.3 Routine submission of material for serology	10	10.0	100.0	10.0	100.0
1.4 Routine submission of material for viral isolation	9	9.0	100.0	9.0	100.0
1.5 Production of reports with monitoring maps identifying risk areas in a timely manner	10	8.3	83.0	6.0	60.0
1.6 Implementation of active tracing of serious cases	10	6.7	67.0	10.0	100.0
1.7 Existence of routine investigation of serious cases	10	10.0	100.0	8.0	80.0
1.8 Investigation of all suspected dengue fever deaths	10	10.0	100.0	10.0	100.0
1.9 Feedback of information to notifying units	10	6.1	61.0	4.5	45.0
1.10 Cases closed in the appropriate period	10	10.0	100.0	10.0	100.0
1.11 Trained epidemiological surveillance technical staff	10	10.0	100.0	10.0	100.0
1.12 Timely and regular exchange of epidemiological information with the neighboring country municipality	10	0.0	61.5	10.0	100.0
2. Vector combat	80	71.0	88.7	77.8	97.2
2.1 Appropriate operationalization of the National Dengue Control Program system	10	10.0	100.0	10.0	100.0
2.2 Implementation of property inspection cycles	10	10.0	100.0	10.0	100.0
2.3 Implementation of actions at strategic points	10	10.0	100.0	10.0	100.0
2.4 Appropriate completion of Aedes aegypti Rapid Index Survey (LIRAa)	10	10.0	100.0	10.0	100.0
2.5 Case blocking implemented	10	10.0	100.0	10.0	100.0
2.6 Endemic disease control agents trained regarding dengue	10	9.5	95.0	10.0	100.0
2.7 Field supervisors trained regarding dengue	10	10.0	100.0	10.0	100.0
2.8 Promotion of joint vector control actions with the neighboring country municipality	10	1.5	15.0	7.8	78.0
3. Assistance to the sick	60	41.4	69.0	35.7	59.5
3.1 Use of risk classification criteria	10	9.2	92.0	8.5	85.0
3.2 Use of follow-up card with suspected dengue cases	10	5.4	54.0	1.4	14.0
3.3 Adoption of a single clinical management protocol used in all health centers based on the 'Dengue: adult and child diagnosis and clinical management’ manual	10	7.6	76.0	8.0	80.0
3.4 Nurses trained regarding dengue	10	6.3	63.0	6.8	68.0
3.5 Doctors trained regarding dengue	10	7.5	75.0	6.0	60.0
3.6 Exams for care of dengue cases available and suitable	10	5.4	54.0	5.0	50.0
4. Integration with Primary Care	50	20.5	41.0	29.1	58.2
4.1 Community Health Agents trained regarding dengue	10	7.1	71.0	9.5	95.0
4.2 Incorporation of dengue control and prevention actions in the Community Health Agents Program and the Family Health Strategy (FHS)	10	5.7	57.0	8.8	88.0
4.3 Incorporation of endemic disease control agents in the FHS	10	5.2	52.0	5.3	50.0
4.4 Unification of the geographical working area between the vector control team and the Community Health Agents Program/FHS	10	0.0	0.0	0.0	0.0
4.5 Systematic meetings routinely held between the vector control team and the Family Health team	10	2.5	25.0	5.5	55.0
5. Environmental sanitation	19	9.0	47.4	9.0	47.4
5.1 Sanitation actions targeted according to entomological and epidemiological information information	10	0.0	0.0	0.0	0.0
5.2 Implementation of urban cleaning task forces	9	9.0	100.0	9.0	100.0
6. Health education, social mobilization and communication	36	24.1	66.9	23.8	66.1
6.1 Implementation of educational actions across the local education network	10	10.0	100.0	10.0	100.0
6.2 Articulation of partnerships with civil society	9	5.1	56.7	4.8	53.3
6.3 Communication and social mobilization technical staff trained regarding dengue	9	9.0	100.0	9.0	100.0
6.4 Preparation of bilingual educational material about dengue prevention	8	0.0	0.0	0.0	0.0
7. Human resources training	10	5.0	50.0	5.0	50.0
7.1 Continuous professional training	10	5.0	50.0	5.0	50.0
8. Legislation	20	17.3	86.5	18.1	90.5
8.1 Knowledge of normative instruments	10	8.1	81.0	8.5	85.0
8.2 Application of normative instruments	10	9.2	92.0	9.6	96.0
9. Political-social support	10	5.0	50.0	5.0	50.0
9.1 Meetings held with the mayor and municipal secretaries to presentat the program and obtain continuous political priority	10	5.0	50.0	5.0	50.0
10. Monitoring and evaluation	29	14.0	48.3	14.0	48.3
10.1 Situation room implemented	10	5.0	50.0	5.0	50.0
10.2 Periodic intersectoral meetings to evaluate program actions	10	0.0	0.0	0.0	0.0
10.3 Follow-up and evaluation visits conducted in the municipality by the State Department of Health	9	9.0	100.0	9.0	100.0
Degree of work process implementation	432	297.4	68.8	315.0	72.9

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Elisângela Martins da Silva Costa - Alameda Vera Cruz, No. 9, bairro Universitário, Corumbá, MS, Brazil. CEP: 79304-033 E-mail: elisams10@gmail.com